HIV 感染者在开始抗逆转录病毒治疗前后血细胞减少症的患病率和危险因素。
Prevalence and Risk Factors of Cytopenia in HIV-Infected Patients before and after the Initiation of HAART.
机构信息
Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
出版信息
Biomed Res Int. 2020 Jan 28;2020:3132589. doi: 10.1155/2020/3132589. eCollection 2020.
BACKGROUND
Cytopenia is a frequent hematological disorder in patients with human immunodeficiency virus (HIV) infection. However, the distribution and risk factors of cytopenia in patients starting highly active anti-retrovirus treatment (HAART) and the effect of HAART on cytopenia were not fully investigated.
METHODS
From November 2004 to August 2016, a retrospective study was conducted to evaluate the prevalence of cytopenia in 4325 HAART-naïve patients. Risk factors of cytopenia at baseline and on recovery from cytopenia were analyzed using logistic regression analysis after 24 months of HAART in Beijing Ditan Hospital.
RESULTS
The prevalence of cytopenia was 19.1% in HIV-naïve patients. Risk factors for cytopenia in HAART-naïve patients were a CD4 cell count<200 cells/L, femaleness, WHO stage IV, coinfection with hepatitis B virus (HBV), BMI <18.5 kg/m, a viral load ≥100,000 copies/ml, and age ≥40 years. In total, 70.2% and 76.4% of patients with cytopenia recovered after 6 and 24 months of HAART, respectively. The predictors of patients without normal blood cells after 24 months HAART were a CD4 cell count of <200 cells/L, femaleness, WHO stage IV, coinfection with hepatitis B virus (HBV), BMI <18.5 kg/m, a viral load ≥100,000 copies/ml, and age ≥40 years. In total, 70.2% and 76.4% of patients with cytopenia recovered after 6 and 24 months of HAART, respectively. The predictors of patients without normal blood cells after 24 months HAART were a CD4 cell count of <200 cells/.
CONCLUSION
Early detection could decrease the prevalence of HIV-related cytopenia, while starting HAART as early as possible seems to be effective for normalization of the blood cells in HIV-infected patients.
背景
血细胞减少症是人类免疫缺陷病毒（HIV）感染患者常见的血液学疾病。然而，在开始高效抗逆转录病毒治疗（HAART）的患者中，血细胞减少症的分布和危险因素以及 HAART 对血细胞减少症的影响尚未得到充分研究。
方法
2004 年 11 月至 2016 年 8 月，对北京地坛医院 4325 例 HAART 初治患者进行回顾性研究，评估 HAART 后 24 个月内血细胞减少症的发生率。采用 logistic 回归分析基线和血细胞减少症恢复时的危险因素。
结果
HIV 初治患者血细胞减少症的患病率为 19.1%。HAART 初治患者血细胞减少症的危险因素为 CD4 细胞计数<200 个/细胞/L、女性、世界卫生组织（WHO）分期Ⅳ期、乙型肝炎病毒（HBV）合并感染、BMI<18.5 kg/m2、病毒载量≥100,000 拷贝/ml 和年龄≥40 岁。共有 70.2%和 76.4%的血细胞减少症患者在 HAART 后 6 个月和 24 个月分别恢复正常。HAART 后 24 个月仍未恢复正常血细胞的患者的预测因素为 CD4 细胞计数<200 个/细胞/L、女性、WHO 分期Ⅳ期、乙型肝炎病毒（HBV）合并感染、BMI<18.5 kg/m2、病毒载量≥100,000 拷贝/ml 和年龄≥40 岁。共有 70.2%和 76.4%的血细胞减少症患者在 HAART 后 6 个月和 24 个月分别恢复正常。HAART 后 24 个月仍未恢复正常血细胞的患者的预测因素为 CD4 细胞计数<200 个/细胞/L。
结论
早期检测可降低 HIV 相关血细胞减少症的发生率，而尽早开始 HAART 似乎对 HIV 感染患者的血细胞恢复正常有效。
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